Responding to violence in U.S. hospitals

For several years, I worked at a psychiatric hospital as a mental health technician. For the most part, I found this job to be very fulfilling. Watching patients who arrived in disarray leave feeling content left me feeling that what I was doing was worthwhile, and the occasional thank you card or call from a previous patient didn’t hurt either. However, there were certainly challenges inherent to this job. One such challenge concerned how best to react to patients who became angry or aggressive. When confronted by such a patient, a common response among the staff was to corral other staff members in an attempt to intimidate the patient into submission. In contrast to staff expectations, however, these attempts were often met by the patient with obstinance, and they sometimes even appeared to encourage further aggressive behaviors.

The media has recently given increased attention to violence in U.S. hospitals like that captured in my account above. Events such as the recent shooting at John Hopkins Hospital in Baltimore, as well as a recent Joint Commission report about increasing rates of violence in hospital emergency rooms, has earned the attention of health care workers and the general public alike. Unfortunately, one thing that can be gathered from these reports and my account above is that most hospital staff members receive only limited training in how to respond to angry or aggressive patients.

Research on the interindividual-intergroup discontinuity informs us that corralling other staff members to confront an angry patient who is alone, as often occurred at my workplace, will likely be ineffective in reducing that patient’s anger or aggression. The interindividual-intergroup discontinuity suggests that interactions between groups, or between groups and individuals, will be more competitive and aggressive than interactions between individuals alone (Meier, Hinsz, & Heimerdinger, 2007). There are three mechanisms that are believed to be responsible for this effect. One mechanism suggests that we fear and distrust other groups more than other individuals. A second mechanism suggests that group members can provide social support for antisocial actions, whereas individuals cannot. The third mechanism concerns identifiability, meaning that our (antisocial) actions are more identifiable when we act alone than when we act in a group. What is the implication of this research for health care workers? When it can be safely done, angry or aggressive patients should be confronted one-on-one.